CS/CS/HB 1503

1	A bill to be entitled
2	An act relating to health care; amending s. 112.0455,
3	F.S., and repealing paragraph (10)(e), relating to a
4	prohibition against applying the Drug-Free Workplace Act
5	retroactively; conforming a cross-reference; amending s.
6	381.00315, F.S.; directing the Department of Health to
7	accept funds from counties, municipalities, and certain
8	other entities for the purchase of certain products made
9	available under a contract with the United States
10	Department of Health and Human Services for the
11	manufacture and delivery of such products in response to a
12	public health emergency; repealing s. 383.325, F.S.,
13	relating to the requirement of a licensed facility under
14	s. 383.305, F.S., to maintain inspection reports; amending
15	s. 395.0197, F.S.; providing for a rebuttable presumption
16	against negligence or malpractice claims for hospitals and
17	their employees or independent contractors under specified
18	circumstances; establishing components for the plan;
19	repealing s. 395.1046, F.S., relating to the investigation
20	of complaints regarding hospitals; repealing s. 395.3037,
21	F.S.; deleting definitions relating to obsolete provisions
22	governing primary and comprehensive stroke centers;
23	amending s. 400.0239, F.S.; deleting an obsolete
24	provision; repealing s. 400.147(10), F.S., relating to a
25	requirement that a nursing home facility report any notice
26	of a filing of a claim for a violation of a resident's
27	rights or a claim of negligence; repealing s. 400.148,
28	F.S., relating to the Medicaid "Up-or-Out" Quality of Care
29	Contract Management Program; repealing s. 400.195, F.S.,
30	relating to reporting requirements for the Agency for
31	Health Care Administration; amending s. 400.476, F.S.;
32	providing requirements for an alternate administrator of a
33	home health agency; revising the duties of the
34	administrator; revising the requirements for a director of
35	nursing for a specified number of home health agencies;
36	prohibiting a home health agency from using an individual
37	as a home health aide unless the person has completed
38	training and an evaluation program; requiring a home
39	health aide to meet certain standards in order to be
40	competent in performing certain tasks; requiring a home
41	health agency and staff to comply with accepted
42	professional standards; providing certain requirements for
43	a written contract between certain personnel and the
44	agency; requiring a home health agency to provide certain
45	services through its employees; authorizing a home health
46	agency to provide additional services with another
47	organization; providing responsibilities of a home health
48	agency when it provides home health aide services through
49	another organization; requiring the home health agency to
50	coordinate personnel who provide home health services;
51	requiring personnel to communicate with the home health
52	agency; amending s. 400.487, F.S.; requiring a home health
53	agency to provide a patient or the patient's legal
54	representative a copy of the agreement between the agency
55	and the patient which specifies the home health services
56	to be provided; providing the rights that are protected by
57	the home health agency; requiring the home health agency
58	to furnish nursing services by or under the supervision of
59	a registered nurse; requiring the home health agency to
60	provide therapy services through a qualified therapist or
61	therapy assistant; providing the duties and qualifications
62	of a therapist and therapy assistant; requiring
63	supervision by a physical therapist or occupational
64	therapist of a physical therapist assistant or
65	occupational therapy assistant; providing duties of a
66	physical therapist assistant or occupational therapy
67	assistant; providing for speech therapy services to be
68	provided by a qualified speech-language pathologist or
69	audiologist; providing for a plan of care; providing that
70	only the staff of a home health agency may administer
71	drugs and treatments as ordered by certain health
72	professionals; providing requirements for verbal orders;
73	providing duties of a registered nurse, licensed practical
74	nurse, home health aide, and certified nursing assistant
75	who work for a home health agency; providing for
76	supervisory visits of services provided by a home health
77	agency; repealing s. 408.802(11), F.S., relating to the
78	applicability of the Health Care Licensing Procedures Act
79	to private review agents; repealing s. 409.912(15)(e),
80	(f), and (g), F.S., relating to a requirement for the
81	Agency for Health Care Administration to submit a report
82	to the Legislature regarding the operations of the CARE
83	program; repealing s. 409.9122(13), F.S., relating to
84	Medicaid managed prepaid plan minimum enrollment levels
85	for plans operating in Miami-Dade County; amending s.
86	409.91255, F.S.; transferring administrative
87	responsibility for the application procedure for federally
88	qualified health centers from the Department of Health to
89	the Agency for Health Care Administration; requiring the
90	Florida Association of Community Health Centers, Inc., to
91	provide support and assume administrative costs for the
92	program; repealing s. 429.12(2), F.S., relating to the
93	sale or transfer of ownership of an assisted living
94	facility; repealing s. 429.23(5), F.S., relating to each
95	assisted living facility's requirement to submit a report
96	to the agency regarding liability claims filed against it;
97	repealing s. 429.911(2)(a), F.S., relating to an
98	intentional or negligent act materially affecting the
99	health or safety of center participants as grounds for
100	which the agency may take action against the owner of an
101	adult day care center or its operator or employee;
102	requiring persons who apply for licensure renewal as a
103	dentist or dental hygienist to furnish certain information
104	to the Department of Health in a dental workforce survey;
105	requiring the Board of Dentistry to issue a
106	nondisciplinary citation and a notice for failure to
107	complete the survey within a specified time; providing
108	notification requirements for the citation; requiring the
109	department to serve as the coordinating body for the
110	purpose of collecting, disseminating, and updating dental
111	workforce data; requiring the department to maintain a
112	database regarding the state's dental workforce; requiring
113	the department to develop strategies to maximize federal
114	and state programs and to work with an advisory body to
115	address matters relating to the state's dental workforce;
116	providing membership of the advisory body; providing for
117	members of the advisory body to serve without
118	compensation; requiring the department to act as a
119	clearinghouse for collecting and disseminating information
120	regarding the dental workforce; requiring the department
121	and the board to adopt rules; providing legislative intent
122	regarding implementation of the act within existing
123	resources; amending s. 499.01, F.S.; authorizing certain
124	business entities to pay for prescription drugs obtained
125	by practitioners licensed under ch. 466, F.S.; amending s.
126	624.91, F.S.; revising the membership of the board of
127	directors of the Florida Healthy Kids Corporation to
128	include a member nominated by the Florida Dental
129	Association and appointed by the Governor; amending s.
130	381.0403, F.S.; deleting provisions relating to the
131	program for graduate medical education innovations and the
132	graduate medical education committee and report;
133	conforming cross-references; amending s. 381.4018, F.S.;
134	providing definitions; requiring the Department of Health
135	to coordinate and enhance activities regarding the reentry
136	of retired military and other physicians into the
137	physician workforce; revising the list of governmental
138	stakeholders that the department is required to work with
139	regarding the state strategic plan and in assessing the
140	state's physician workforce; creating the Physician
141	Workforce Advisory Council; providing membership of the
142	council; providing for appointments to the council;
143	providing terms of membership; providing for removal of a
144	council member; providing for a chair and vice chair of
145	the council; providing that council members are not
146	entitled to receive compensation or reimbursement for per
147	diem or travel expenses; providing the duties of the
148	council; establishing the physician workforce graduate
149	medical education innovation pilot projects under the
150	department; providing the purposes of the pilot projects;
151	providing for the appropriation of state funds for the
152	pilot projects; requiring the pilot projects to meet
153	certain policy needs of the physician workforce in this
154	state; providing criteria for prioritizing proposals for
155	pilot projects; requiring the department to adopt by rule
156	appropriate performance measures; requiring participating
157	pilot projects to submit an annual report to the
158	department; requiring state funds to be used to supplement
159	funds from other sources; requiring the department to
160	adopt rules; amending ss. 458.3192 and 459.0082, F.S.;
161	requiring the department to determine by geographic area
162	and specialty the number of physicians and osteopathic
163	physicians who plan to relocate outside the state,
164	practice medicine in this state, and reduce or modify the
165	scope of their practice; authorizing the department to
166	report additional information in its findings to the
167	Governor and the Legislature; amending s. 458.315, F.S.;
168	revising the standards for the Board of Medicine to issue
169	a temporary certificate to a certain physicians to
170	practice medicine in areas of critical need; authorizing
171	the State Surgeon General to designate areas of critical
172	need; creating s. 459.0076, F.S.; authorizing the Board of
173	Osteopathic Medicine to issue temporary certificates to
174	osteopathic physicians who meet certain requirements to
175	practice osteopathic medicine in areas of critical need;
176	providing restrictions for issuance of a temporary
177	certificate; authorizing the State Surgeon General to
178	designate areas of critical need; authorizing the Board of
179	Osteopathic Medicine to waive the application fee and
180	licensure fees for obtaining temporary certificates for
181	certain purposes; providing an effective date.
182
183	Be It Enacted by the Legislature of the State of Florida:
184
185	Section 1.  Paragraph (e) of subsection (10) of section
186	112.0455, Florida Statutes, is repealed, and paragraph (e) of
187	subsection (14) of that section is amended to read:
188	112.0455  Drug-Free Workplace Act.-
189	(14)  DISCIPLINE REMEDIES.-
190	(e)  Upon resolving an appeal filed pursuant to paragraph
191	(c), and finding a violation of this section, the commission may
192	order the following relief:
193	1.  Rescind the disciplinary action, expunge related
194	records from the personnel file of the employee or job applicant
195	and reinstate the employee.
196	2.  Order compliance with paragraph (10)(f)(g).
197	3.  Award back pay and benefits.
198	4.  Award the prevailing employee or job applicant the
199	necessary costs of the appeal, reasonable attorney's fees, and
200	expert witness fees.
201	Section 2.  Subsection (3) is added to section 381.00315,
202	Florida Statutes, to read:
203	381.00315  Public health advisories; public health
204	emergencies.-The State Health Officer is responsible for
205	declaring public health emergencies and issuing public health
206	advisories.
207	(3)  To facilitate effective emergency management, when the
208	United States Department of Health and Human Services contracts
209	for the manufacture and delivery of licensable products in
210	response to a public health emergency and the terms of those
211	contracts are made available to the states, the department shall
212	accept funds provided by cities, counties, and other entities
213	designated in the state emergency management plan required under
214	s. 252.35(2)(a) for the purpose of participation in those
215	contracts. The department shall deposit those funds in the
216	Grants and Donations Trust Fund and expend those funds on behalf
217	of the donor city, county, or other entity for the purchase of
218	the licensable products made available under the contract.
219	Section 3.  Section 383.325, Florida Statutes, is repealed.
220	Section 4.  Subsection (20) is added to section 395.0197,
221	Florida Statutes, to read:
222	395.0197  Internal risk management program.-
223	(20)  A hospital's implementation of a comprehensive plan
224	to reduce health care-associated infections before a patient
225	becomes infected constitutes a rebuttable presumption against a
226	claim of negligence or malpractice by the hospital or any of its
227	employees or independent contractors. Any such plan must include
228	the following components:
229	(a)  A baseline measurement of health care-associated
230	infections in a hospital that uses the National Healthcare
231	Safety Network and Centers for Disease Control and Prevention
232	surveillance definitions and reports the number of infections in
233	each category relating to the volume of possible cases in the
234	hospital.
235	(b)  A goal for reducing the incidence of infections by a
236	specific amount in a defined period of time. A hospital's goal
237	for reduction of infections must be commensurate with the
238	national goal for reducing each type of health care-associated
239	infection.
240	(c)  An action plan for reducing each type of infection,
241	including the use of real-time infection surveillance technology
242	or automated infection control or prevention technology.
243	(d)  Methods for making information available to patients
244	and the public regarding baseline measurements and periodic
245	reports on the hospital's progress in improving those measures.
246	Section 5.  Section 395.1046, Florida Statutes, is
247	repealed.
248	Section 6.  Section 395.3037, Florida Statutes, is
249	repealed.
250	Section 7.  Paragraph (g) of subsection (2) of section
251	400.0239, Florida Statutes, is amended to read:
252	400.0239  Quality of Long-Term Care Facility Improvement
253	Trust Fund.-
254	(2)  Expenditures from the trust fund shall be allowable
255	for direct support of the following:
256	(g)  Other initiatives authorized by the Centers for
257	Medicare and Medicaid Services for the use of federal civil
258	monetary penalties, including projects recommended through the
259	Medicaid "Up-or-Out" Quality of Care Contract Management Program
260	pursuant to s. 400.148.
261	Section 8.  Subsection (10) of section 400.147, Florida
262	Statutes, is repealed.
263	Section 9.  Section 400.148, Florida Statutes, is repealed.
264	Section 10.  Section 400.195, Florida Statutes, is
265	repealed.
266	Section 11.  Section 400.476, Florida Statutes, is amended
267	to read:
268	400.476  Staffing requirements; notifications; limitations
269	on staffing services.-
270	(1)  ADMINISTRATOR.-
271	(a)  An administrator may manage only one home health
272	agency, except that an administrator may manage up to five home
273	health agencies if all five home health agencies have identical
274	controlling interests as defined in s. 408.803 and are located
275	within one agency geographic service area or within an
276	immediately contiguous county. If the home health agency is
277	licensed under this chapter and is part of a retirement
278	community that provides multiple levels of care, an employee of
279	the retirement community may administer the home health agency
280	and up to a maximum of four entities licensed under this chapter
281	or chapter 429 which all have identical controlling interests as
282	defined in s. 408.803. An administrator shall designate, in
283	writing, for each licensed entity, a qualified alternate
284	administrator to serve during the administrator's absence. An
285	alternate administrator must meet the requirements in this
286	paragraph and s. 400.462(1).
287	(b)  An administrator of a home health agency who is a
288	licensed physician, physician assistant, or registered nurse
289	licensed to practice in this state may also be the director of
290	nursing for a home health agency. An administrator may serve as
291	a director of nursing for up to the number of entities
292	authorized in subsection (2) only if there are 10 or fewer full-
293	time equivalent employees and contracted personnel in each home
294	health agency.
295	(c)  The administrator shall organize and direct the
296	agency's ongoing functions, maintain an ongoing liaison with the
297	board members and the staff, employ qualified personnel and
298	ensure adequate staff education and evaluations, ensure the
299	accuracy of public informational materials and activities,
300	implement an effective budgeting and accounting system, and
301	ensure that the home health agency operates in compliance with
302	this part and part II of chapter 408 and rules adopted for these
303	laws.
304	(d)  The administrator shall clearly set forth in writing
305	the organizational chart, services furnished, administrative
306	control authority, and lines of authority for the delegation of
307	responsibilities for patient care. These responsibilities must
308	be readily identifiable. Administrative and supervisory
309	functions may not be delegated to another agency or
310	organization, and the primary home health agency shall monitor
311	and control all services that are not furnished directly,
312	including services provided through contracts.
313	(2)  DIRECTOR OF NURSING.-
314	(a)  A director of nursing may be the director of nursing
315	for:
316	1.  Up to two licensed home health agencies if the agencies
317	have identical controlling interests as defined in s. 408.803
318	and are located within one agency geographic service area or
319	within an immediately contiguous county; or
320	2.  Up to five licensed home health agencies if:
321	a.  All of the home health agencies have identical
322	controlling interests as defined in s. 408.803;
323	b.  All of the home health agencies are located within one
324	agency geographic service area or within an immediately
325	contiguous county; and
326	c.  Each home health agency has a registered nurse who
327	meets the qualifications of a director of nursing and who has a
328	written delegation from the director of nursing to serve as the
329	director of nursing for that home health agency when the
330	director of nursing is not present; and.
331	d.  This person, or a similarly qualified alternate, is
332	available at all times during operating hours and participates
333	in all activities relevant to the professional services
334	furnished, including, but not limited to, the oversight of
335	nursing services, home health aides, and certified nursing
336	assistants and the assignment of personnel.
337
338	If a home health agency licensed under this chapter is part of a
339	retirement community that provides multiple levels of care, an
340	employee of the retirement community may serve as the director
341	of nursing of the home health agency and up to a maximum of four
342	entities, other than home health agencies, licensed under this
343	chapter or chapter 429 which all have identical controlling
344	interests as defined in s. 408.803.
345	(b)  A home health agency that provides skilled nursing
346	care may not operate for more than 30 calendar days without a
347	director of nursing. A home health agency that provides skilled
348	nursing care and the director of nursing of a home health agency
349	must notify the agency within 10 business days after termination
350	of the services of the director of nursing for the home health
351	agency. A home health agency that provides skilled nursing care
352	must notify the agency of the identity and qualifications of the
353	new director of nursing within 10 days after the new director is
354	hired. If a home health agency that provides skilled nursing
355	care operates for more than 30 calendar days without a director
356	of nursing, the home health agency commits a class II
357	deficiency. In addition to the fine for a class II deficiency,
358	the agency may issue a moratorium in accordance with s. 408.814
359	or revoke the license. The agency shall fine a home health
360	agency that fails to notify the agency as required in this
361	paragraph $1,000 for the first violation and $2,000 for a repeat
362	violation. The agency may not take administrative action against
363	a home health agency if the director of nursing fails to notify
364	the department upon termination of services as the director of
365	nursing for the home health agency.
366	(c)  A home health agency that is not Medicare or Medicaid
367	certified and does not provide skilled care or provides only
368	physical, occupational, or speech therapy is not required to
369	have a director of nursing and is exempt from paragraph (b).
370	(3)  TRAINING.-A home health agency shall ensure that each
371	certified nursing assistant employed by or under contract with
372	the home health agency and each home health aide employed by or
373	under contract with the home health agency is adequately trained
374	to perform the tasks of a home health aide in the home setting.
375	(a)  The home health agency may not use as a home health
376	aide on a full-time, temporary, per diem, or other basis any
377	individual to provide services unless the individual has
378	completed a training and competency evaluation program, or a
379	competency evaluation program, as permitted in s. 400.497, which
380	meets the minimum standards established by the agency in state
381	rules.
382	(b)  A home health aide is not competent in any task for
383	which he or she is evaluated as "unsatisfactory." The aide must
384	perform any such task only under direct supervision by a
385	licensed nurse until he or she receives training in the task and
386	satisfactorily passes a subsequent evaluation in performing the
387	task. A home health aide has not successfully passed a
388	competency evaluation if the aide does not have a passing score
389	on the test as specified by agency rule.
390	(4)  STAFFING.-Staffing services may be provided anywhere
391	within the state.
392	(5)  PERSONNEL.-
393	(a)  The home health agency and its staff must comply with
394	accepted professional standards and principles that apply to
395	professionals, including, but not limited to, the state practice
396	acts and the home health agency's policies and procedures.
397	(b)  If personnel under hourly or per-visit contracts are
398	used by the home health agency, there must be a written contract
399	between those personnel and the agency which specifies the
400	following requirements:
401	1.  Acceptance for care only of patients by the primary
402	home health agency.
403	2.  The services to be furnished.
404	3.  The necessity to conform to all applicable agency
405	policies, including personnel qualifications.
406	4.  The responsibility for participating in developing
407	plans of care.
408	5.  The manner in which services are controlled,
409	coordinated, and evaluated by the primary home health agency.
410	6.  The procedures for submitting clinical and progress
411	notes, scheduling visits, and providing periodic patient
412	evaluations.
413	7.  The procedures for payment for services furnished under
414	the contract.
415	(c)  A home health agency shall directly provide at least
416	one of the types of authorized services through home health
417	agency employees, but may provide additional services under
418	arrangements with another agency or organization. Services
419	furnished under such arrangements must have a written contract
420	conforming to the requirements specified in paragraph (b).
421	(d)  If home health aide services are provided by an
422	individual who is not employed directly by the home health
423	agency, the services of the home health aide must be provided
424	under arrangements as stated in paragraphs (b) and (c). If the
425	home health agency chooses to provide home health aide services
426	under arrangements with another organization, the
427	responsibilities of the home health agency include, but are not
428	limited to:
429	1.  Ensuring the overall quality of the care provided by
430	the aide.
431	2.  Supervising the aide's services as described in s.
432	400.487.
433	3.  Ensuring that each home health aide providing services
434	under arrangements with another organization has met the
435	training requirements or competency evaluation requirements of
436	s. 400.497.
437	(e)  The home health agency shall coordinate the efforts of
438	all personnel furnishing services, and the personnel shall
439	maintain communication with the home health agency to ensure
440	that personnel efforts support the objectives outlined in the
441	plan of care. The clinical record or minutes of case conferences
442	shall ensure that effective interchange, reporting, and
443	coordination of patient care occurs.
444	Section 12.  Section 400.487, Florida Statutes, is amended
445	to read:
446	400.487  Home health service agreements; physician's,
447	physician assistant's, and advanced registered nurse
448	practitioner's treatment orders; patient assessment;
449	establishment and review of plan of care; provision of services;
450	orders not to resuscitate.-
451	(1)  Services provided by a home health agency must be
452	covered by an agreement between the home health agency and the
453	patient or the patient's legal representative specifying the
454	home health services to be provided, the rates or charges for
455	services paid with private funds, and the sources of payment,
456	which may include Medicare, Medicaid, private insurance,
457	personal funds, or a combination thereof. The home health agency
458	shall provide a copy of the agreement to the patient or the
459	patient's legal representative. A home health agency providing
460	skilled care must make an assessment of the patient's needs
461	within 48 hours after the start of services.
462	(2)  When required by the provisions of chapter 464; part
463	I, part III, or part V of chapter 468; or chapter 486, the
464	attending physician, physician assistant, or advanced registered
465	nurse practitioner, acting within his or her respective scope of
466	practice, shall establish treatment orders for a patient who is
467	to receive skilled care. The treatment orders must be signed by
468	the physician, physician assistant, or advanced registered nurse
469	practitioner before a claim for payment for the skilled services
470	is submitted by the home health agency. If the claim is
471	submitted to a managed care organization, the treatment orders
472	must be signed within the time allowed under the provider
473	agreement. The treatment orders shall be reviewed, as frequently
474	as the patient's illness requires, by the physician, physician
475	assistant, or advanced registered nurse practitioner in
476	consultation with the home health agency.
477	(3)  A home health agency shall arrange for supervisory
478	visits by a registered nurse to the home of a patient receiving
479	home health aide services as specified in subsection (9) in
480	accordance with the patient's direction, approval, and agreement
481	to pay the charge for the visits.
482	(4)  The home health agency shall protect and promote the
483	rights of each individual under its care, including each of the
484	following rights:
485	(a)  Notice of rights.-The home health agency shall provide
486	the patient with a written notice of the patient's rights in
487	advance of furnishing care to the patient or during the initial
488	evaluation visit before the initiation of treatment. The home
489	health agency must maintain documentation showing that it has
490	complied with the requirements of this section.
491	(b)  Exercise of rights and respect for property and
492	person.-
493	1.  The patient has the right to exercise his or her rights
494	as a patient of the home health agency.
495	2.  The patient has the right to have his or her property
496	treated with respect.
497	3.  The patient has the right to voice grievances regarding
498	treatment or care that is or fails to be furnished, or regarding
499	the lack of respect for property by anyone who is furnishing
500	services on behalf of the home health agency, and not be
501	subjected to discrimination or reprisal for doing so.
502	4.  The home health agency must investigate complaints made
503	by a patient or the patient's family or guardian regarding
504	treatment or care that is or fails to be furnished or regarding
505	the lack of respect for the patient's property by anyone
506	furnishing services on behalf of the home health agency. The
507	home health agency shall document the existence of the complaint
508	and its resolution.
509	5.  The patient and his or her immediate family or
510	representative must be informed of the right to report
511	complaints via the statewide toll-free telephone number to the
512	agency as required in s. 408.810.
513	(c)  Right to be informed and to participate in planning
514	care and treatment.-
515	1.  The patient has the right to be informed, in advance,
516	about the care to be furnished and of any changes in the care to
517	be furnished. The home health agency shall advise the patient in
518	advance of which disciplines will furnish care and the frequency
519	of visits proposed to be furnished. The home health agency must
520	advise the patient in advance of any change in the plan of care
521	before the change is made.
522	2.  The patient has the right to participate in the
523	planning of the care. The home health agency must advise the
524	patient in advance of the right to participate in planning the
525	care or treatment and in planning changes in the care or
526	treatment. Each patient has the right to be informed of and to
527	participate in the planning of his or her care. Each patient
528	must be provided, upon request, a copy of the plan of care
529	established and maintained for that patient by the home health
530	agency.
531	(5)  When nursing services are ordered, the home health
532	agency to which a patient has been admitted for care must
533	provide the initial admission visit, all service evaluation
534	visits, and the discharge visit by a direct employee. Services
535	provided by others under contractual arrangements to a home
536	health agency must be monitored and managed by the admitting
537	home health agency. The admitting home health agency is fully
538	responsible for ensuring that all care provided through its
539	employees or contract staff is delivered in accordance with this
540	part and applicable rules.
541	(6)  The skilled care services provided by a home health
542	agency, directly or under contract, must be supervised and
543	coordinated in accordance with the plan of care. The home health
544	agency shall furnish skilled nursing services by or under the
545	supervision of a registered nurse and in accordance with the
546	plan of care. Any therapy services offered directly or under
547	arrangement by the home health agency must be provided by a
548	qualified therapist or by a qualified therapy assistant under
549	the supervision of a qualified therapist and in accordance with
550	the plan of care.
551	(a)  Duties and qualifications.-A qualified therapist shall
552	assist the physician in evaluating the level of function, help
553	develop or revise the plan of care, prepare clinical and
554	progress notes, advise and consult with the family and other
555	agency personnel, and participate in in-service programs. The
556	therapist or therapy assistant must meet the qualifications in
557	the state practice acts and applicable rules.
558	(b)  Physical therapist assistants and occupational therapy
559	assistants.-Services provided by a physical therapist assistant
560	or occupational therapy assistant must be under the supervision
561	of a qualified physical therapist or occupational therapist as
562	required in chapter 486 and part III of chapter 468,
563	respectively, and applicable rules. A physical therapist
564	assistant or occupational therapy assistant shall perform
565	services planned, delegated, and supervised by the therapist,
566	assist in preparing clinical notes and progress reports,
567	participate in educating the patient and his or her family, and
568	participate in in-service programs.
569	(c)  Speech therapy services.-Speech therapy services shall
570	be furnished only by or under supervision of a qualified speech-
571	language pathologist or audiologist as required in part I of
572	chapter 468 and applicable rules.
573	(d)  Care follows a written plan of care.-The plan of care
574	shall be reviewed by the physician or health professional who
575	provided the treatment orders pursuant to subsection (2) and
576	home health agency personnel as often as the severity of the
577	patient's condition requires, but at least once every 60 days or
578	more when there is a patient-elected transfer, a significant
579	change in condition, or a discharge and return to the same home
580	health agency during the 60-day episode. Professional staff of a
581	home health agency shall promptly alert the physician or other
582	health professional who provided the treatment orders of any
583	change that suggests a need to alter the plan of care.
584	(e)  Administration of drugs and treatment.-Only
585	professional staff of a home health agency may administer drugs
586	and treatments as ordered by the physician or health
587	professional pursuant to subsection (2), with the exception of
588	influenza and pneumococcal polysaccharide vaccines, which may be
589	administered according to the policy of the home health agency
590	developed in consultation with a physician and after an
591	assessment for contraindications. Verbal orders shall be in
592	writing and signed and dated with the date of receipt by the
593	registered nurse or qualified therapist who is responsible for
594	furnishing or supervising the ordered service. A verbal order
595	may be accepted only by personnel who are authorized to do so by
596	applicable state laws, rules, and internal policies of the home
597	health agency.
598	(7)  A registered nurse shall conduct the initial
599	evaluation visit, regularly reevaluate the patient's nursing
600	needs, initiate the plan of care and necessary revisions,
601	furnish those services requiring substantial and specialized
602	nursing skill, initiate appropriate preventive and
603	rehabilitative nursing procedures, prepare clinical and progress
604	notes, coordinate services, inform the physician and other
605	personnel of changes in the patient's condition and needs,
606	counsel the patient and his or her family in meeting nursing and
607	related needs, participate in in-service programs, and supervise
608	and teach other nursing personnel, unless the home health agency
609	providing the home health aide services is not Medicare-
610	certified or Medicaid-certified and does not provide skilled
611	care.
612	(8)  A licensed practical nurse shall furnish services in
613	accordance with agency policies, prepare clinical and progress
614	notes, assist the physician and registered nurse in performing
615	specialized procedures, prepare equipment and materials for
616	treatments observing aseptic technique as required, and assist
617	the patient in learning appropriate self-care techniques.
618	(9)  A home health aide and certified nursing assistant
619	shall provide services that are in the service provision plan
620	provided in s. 400.491 and other services that the home health
621	aide or certified nursing assistant is permitted to perform
622	under state law. The duties of a home health aide or certified
623	nursing assistant include the provision of hands-on personal
624	care, performance of simple procedures as an extension of
625	therapy or nursing services, assistance in ambulation or
626	exercises, and assistance in administering medications that are
627	ordinarily self-administered and are specified in agency rules.
628	Any services by a home health aide which are offered by a home
629	health agency must be provided by a qualified home health aide
630	or certified nursing assistant.
631	(a)  Assignment and duties.-A home health aide or certified
632	nursing assistant shall be assigned to a specific patient by a
633	registered nurse, unless the home health agency providing the
634	home health aide services is not Medicare-certified or Medicaid-
635	certified and does not provide skilled care. Written patient
636	care instructions for the home health aide and certified nursing
637	assistant must be prepared by the registered nurse or other
638	appropriate professional who is responsible for the supervision
639	of the home health aide and certified nursing assistant as
640	stated in this section.
641	(b)  Supervision.-If a patient receives skilled nursing
642	care, the registered nurse shall perform the supervisory visit.
643	If the patient is not receiving skilled nursing care but is
644	receiving physical therapy, occupational therapy, or speech-
645	language pathology services, the appropriate therapist may
646	provide the supervision. A registered nurse or other
647	professional must make an onsite visit to the patient's home at
648	least once every 2 weeks. The visit is not required while the
649	aide is providing care.
650	(c)  Supervisory visits.-If home health aide services are
651	provided to a patient who is not receiving skilled nursing care,
652	physical or occupational therapy, or speech-language pathology
653	services, a registered nurse must make a supervisory visit to
654	the patient's home at least once every 60 days, unless the home
655	health agency providing the home health aide services is not
656	Medicare-certified or Medicaid-certified and does not provide
657	skilled care, either directly or through contracts. The
658	registered nurse shall ensure that the aide is properly caring
659	for the patient and each supervisory visit must occur while the
660	home health aide is providing patient care. In addition to the
661	requirements in this subsection, a home health agency shall
662	arrange for additional supervisory visits by a registered nurse
663	to the home of a patient receiving home health aide services in
664	accordance with the patient's direction, approval, and agreement
665	to pay the charge for the visits.
666	(10)(7)  Home health agency personnel may withhold or
667	withdraw cardiopulmonary resuscitation if presented with an
668	order not to resuscitate executed pursuant to s. 401.45. The
669	agency shall adopt rules providing for the implementation of
670	such orders. Home health personnel and agencies shall not be
671	subject to criminal prosecution or civil liability, nor be
672	considered to have engaged in negligent or unprofessional
673	conduct, for withholding or withdrawing cardiopulmonary
674	resuscitation pursuant to such an order and rules adopted by the
675	agency.
676	Section 13.  Subsection (11) of section 408.802, Florida
677	Statutes, is repealed.
678	Section 14.  Paragraphs (e), (f), and (g) of subsection
679	(15) of section 409.912, Florida Statutes, are repealed.
680	Section 15.  Subsection (13) of section 409.9122, Florida
681	Statutes, is repealed.
682	Section 16.  Section 409.91255, Florida Statutes, is
683	amended to read:
684	409.91255  Federally qualified health center access
685	program.-
686	(1)  SHORT TITLE.-This section may be cited as the
687	"Community Health Center Access Program Act."
688	(2)  LEGISLATIVE FINDINGS AND INTENT.-
689	(a)  The Legislature finds that, despite significant
690	investments in health care programs, nearly 6 more than 2
691	million low-income Floridians, primarily the working poor and
692	minority populations, continue to lack access to basic health
693	care services. Further, the Legislature recognizes that
694	federally qualified health centers have a proven record of
695	providing cost-effective, comprehensive primary and preventive
696	health care and are uniquely qualified to address the lack of
697	adequate health care services for the uninsured.
698	(b)  It is the intent of the Legislature to recognize the
699	significance of increased federal investments in federally
700	qualified health centers and to leverage that investment through
701	the creation of a program to provide for the expansion of the
702	primary and preventive health care services offered by federally
703	qualified health centers. Further, such a program will support
704	the coordination of federal, state, and local resources to
705	assist such health centers in developing an expanded community-
706	based primary care delivery system.
707	(3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.-The
708	agency shall administer Department of Health shall develop a
709	program for the expansion of federally qualified health centers
710	for the purpose of providing comprehensive primary and
711	preventive health care and urgent care services that may reduce
712	the morbidity, mortality, and cost of care among the uninsured
713	population of the state. The program shall provide for
714	distribution of financial assistance to federally qualified
715	health centers that apply and demonstrate a need for such
716	assistance in order to sustain or expand the delivery of primary
717	and preventive health care services. In selecting centers to
718	receive this financial assistance, the program:
719	(a)  Shall give preference to communities that have few or
720	no community-based primary care services or in which the current
721	services are unable to meet the community's needs. To assist in
722	the assessment and identification of areas of critical need, a
723	federally qualified health-center-based statewide assessment and
724	strategic plan shall be developed by the Florida Association of
725	Community Health Centers, Inc., every 5 years, beginning January
726	1, 2011.
727	(b)  Shall require that primary care services be provided
728	to the medically indigent using a sliding fee schedule based on
729	income.
730	(c)  Shall promote allow innovative and creative uses of
731	federal, state, and local health care resources.
732	(d)  Shall require that the funds provided be used to pay
733	for operating costs of a projected expansion in patient
734	caseloads or services or for capital improvement projects.
735	Capital improvement projects may include renovations to existing
736	facilities or construction of new facilities, provided that an
737	expansion in patient caseloads or services to a new patient
738	population will occur as a result of the capital expenditures.
739	The agency department shall include in its standard contract
740	document a requirement that any state funds provided for the
741	purchase of or improvements to real property are contingent upon
742	the contractor granting to the state a security interest in the
743	property at least to the amount of the state funds provided for
744	at least 5 years from the date of purchase or the completion of
745	the improvements or as further required by law. The contract
746	must include a provision that, as a condition of receipt of
747	state funding for this purpose, the contractor agrees that, if
748	it disposes of the property before the agency's department's
749	interest is vacated, the contractor will refund the
750	proportionate share of the state's initial investment, as
751	adjusted by depreciation.
752	(e)  Shall May require in-kind support from other sources.
753	(f)  Shall promote May encourage coordination among
754	federally qualified health centers, other private sector
755	providers, and publicly supported programs.
756	(g)  Shall promote allow the development of community
757	emergency room diversion programs in conjunction with local
758	resources, providing extended hours of operation to urgent care
759	patients. Diversion programs shall include case management for
760	emergency room followup care.
761	(4)  EVALUATION OF APPLICATIONS.-A review panel shall be
762	established, consisting of four persons appointed by the
763	Secretary of Health Care Administration State Surgeon General
764	and three persons appointed by the chief executive officer of
765	the Florida Association of Community Health Centers, Inc., to
766	review all applications for financial assistance under the
767	program. Applicants shall specify in the application whether the
768	program funds will be used for the expansion of patient
769	caseloads or services or for capital improvement projects to
770	expand and improve patient facilities. The panel shall use the
771	following elements in reviewing application proposals and shall
772	determine the relative weight for scoring and evaluating these
773	elements:
774	(a)  The target population to be served.
775	(b)  The health benefits to be provided.
776	(c)  The methods that will be used to measure cost-
777	effectiveness.
778	(d)  How patient satisfaction will be measured.
779	(e)  The proposed internal quality assurance process.
780	(f)  Projected health status outcomes.
781	(g)  How data will be collected to measure cost-
782	effectiveness, health status outcomes, and overall achievement
783	of the goals of the proposal.
784	(h)  All resources, including cash, in-kind, voluntary, or
785	other resources that will be dedicated to the proposal.
786	(5)  ADMINISTRATION AND TECHNICAL ASSISTANCE.-The agency
787	shall Department of Health may contract with the Florida
788	Association of Community Health Centers, Inc., to develop and
789	coordinate administer the program and provide technical
790	assistance to the federally qualified health centers selected to
791	receive financial assistance. The contracted entity shall be
792	responsible for program support and assume all costs related to
793	administration of this program.
794	Section 17.  Subsection (2) of section 429.12, Florida
795	Statutes, is repealed.
796	Section 18.  Subsection (5) of section 429.23, Florida
797	Statutes, is repealed.
798	Section 19.  Paragraph (a) of subsection (2) of section
799	429.911, Florida Statutes, is repealed.
800	Section 20.  Dental workforce survey.-
801	(1)  Beginning in 2012, each person who applies for
802	licensure renewal as a dentist or dental hygienist under chapter
803	466, Florida Statutes, must, in conjunction with the renewal of
804	such license under procedures and forms adopted by the Board of
805	Dentistry and in addition to any other information that may be
806	required from the applicant, furnish the following information
807	to the Department of Health, working in conjunction with the
808	board, in a dental workforce survey:
809	(a)  Licensee information, including, but not limited to:
810	1.  The name of the dental school or dental hygiene program
811	that the dentist or dental hygienist graduated from and the year
812	of graduation.
813	2.  The year that the dentist or dental hygienist began
814	practicing or working in this state.
815	3.  The geographic location of the dentist's or dental
816	hygienist's practice or address within the state.
817	4.  For a dentist in private practice:
818	a.  The number of full-time dental hygienists employed by
819	the dentist during the reporting period.
820	b.  The number of full-time dental assistants employed by
821	the dentist during the reporting period.
822	c.  The average number of patients treated per week by the
823	dentist during the reporting period.
824	d.  The settings where the dental care was delivered.
825	5.  Anticipated plans of the dentist to change the status
826	of his or her license or practice.
827	6.  The dentist's areas of specialty or certification.
828	7.  The year that the dentist completed a specialty program
829	recognized by the American Dental Association.
830	8.  For a hygienist:
831	a.  The average number of patients treated per week by the
832	hygienist during the reporting period.
833	b.  The settings where the dental care was delivered.
834	9.  The dentist's memberships in professional
835	organizations.
836	10.  The number of pro bono hours provided by the dentist
837	or dental hygienist during the last biennium.
838	(b)  Information concerning the availability and trends
839	relating to critically needed services, including, but not
840	limited to, the following types of care provided by the dentist
841	or dental hygienist:
842	1.  Dental care to children having special needs.
843	2.  Geriatric dental care.
844	3.  Dental services in emergency departments.
845	4.  Medicaid services.
846	5.  Other critically needed specialty areas, as determined
847	by the advisory body.
848	(2)  In addition to the completed survey, the dentist or
849	dental hygienist must submit a statement that the information
850	provided is true and accurate to the best of his or her
851	knowledge and belief.
852	(3)  Beginning in 2012, renewal of a license by a dentist
853	or dental hygienist licensed under chapter 466, Florida
854	Statutes, is not contingent upon the completion and submission
855	of the dental workforce survey; however, for any subsequent
856	license renewal, the board may not renew the license of any
857	dentist or dental hygienist until the survey required under this
858	section is completed and submitted by the licensee.
859	(4)(a)  Beginning in 2012, the Board of Dentistry shall
860	issue a nondisciplinary citation to any dentist or dental
861	hygienist licensed under chapter 466, Florida Statutes, who
862	fails to complete the survey within 90 days after the renewal of
863	his or her license to practice as a dentist or dental hygienist.
864	(b)  The citation must notify a dentist or dental hygienist
865	who fails to complete the survey required by this section that
866	his or her license will not be renewed for any subsequent
867	license renewal unless the dentist or dental hygienist completes
868	the survey.
869	(c)  In conjunction with issuing the license renewal notice
870	required by s. 456.038, Florida Statutes, the board shall notify
871	each dentist or dental hygienist licensed under chapter 466,
872	Florida Statutes, who fails to complete the survey that the
873	survey must be completed before the subsequent license renewal.
874	Section 21.  (1)  The Department of Health shall serve as
875	the coordinating body for the purpose of collecting and
876	regularly updating and disseminating dental workforce data. The
877	department shall work with multiple stakeholders, including the
878	Florida Dental Association and the Florida Dental Hygiene
879	Association, to assess and share with all communities of
880	interest all data collected in a timely fashion.
881	(2)  The Department of Health shall maintain a current
882	database to serve as a statewide source of data concerning the
883	dental workforce. The department, in conjunction with the Board
884	of Dentistry, shall also:
885	(a)  Develop strategies to maximize federal and state
886	programs that provide incentives for dentists to practice in
887	shortage areas that are federally designated. Strategies shall
888	include programs such as the Florida Health Services Corps
889	established under s. 381.0302, Florida Statutes.
890	(b)  Work in conjunction with an advisory body to address
891	matters relating to the state's dental workforce. The advisory
892	body shall provide input on developing questions for the dentist
893	workforce survey. The advisory body shall include, but need not
894	be limited to, the State Surgeon General or his or her designee,
895	the dean of each dental school accredited in the United States
896	and based in this state or his or her designee, a representative
897	from the Florida Dental Association, a representative from the
898	Florida Dental Hygiene Association, a representative from the
899	Board of Dentistry, and a dentist from each of the dental
900	specialties recognized by the American Dental Association's
901	Commission on Dental Accreditation. Members of the advisory body
902	shall serve without compensation.
903	(c)  Act as a clearinghouse for collecting and
904	disseminating information concerning the dental workforce.
905	(3)  The Department of Health and the Board of Dentistry
906	shall adopt rules necessary to administer this section.
907	Section 22.  It is the intent of the Legislature that the
908	Department of Health and the Board of Dentistry implement the
909	provisions of sections 16 through 20 of this act within existing
910	resources.
911	Section 23.  Paragraph (t) of subsection (2) of section
912	499.01, Florida Statutes, is amended to read:
913	499.01  Permits.-
914	(2)  The following permits are established:
915	(t)  Health care clinic establishment permit.-Effective
916	January 1, 2009, a health care clinic establishment permit is
917	required for the purchase of a prescription drug by a place of
918	business at one general physical location that provides health
919	care or veterinary services, which is owned and operated by a
920	business entity that has been issued a federal employer tax
921	identification number. For the purpose of this paragraph, the
922	term "qualifying practitioner" means a licensed health care
923	practitioner defined in s. 456.001, or a veterinarian licensed
924	under chapter 474, who is authorized under the appropriate
925	practice act to prescribe and administer a prescription drug.
926	1.  An establishment must provide, as part of the
927	application required under s. 499.012, designation of a
928	qualifying practitioner who will be responsible for complying
929	with all legal and regulatory requirements related to the
930	purchase, recordkeeping, storage, and handling of the
931	prescription drugs. In addition, the designated qualifying
932	practitioner shall be the practitioner whose name, establishment
933	address, and license number is used on all distribution
934	documents for prescription drugs purchased or returned by the
935	health care clinic establishment. Upon initial appointment of a
936	qualifying practitioner, the qualifying practitioner and the
937	health care clinic establishment shall notify the department on
938	a form furnished by the department within 10 days after such
939	employment. In addition, the qualifying practitioner and health
940	care clinic establishment shall notify the department within 10
941	days after any subsequent change.
942	2.  The health care clinic establishment must employ a
943	qualifying practitioner at each establishment.
944	3.  In addition to the remedies and penalties provided in
945	this part, a violation of this chapter by the health care clinic
946	establishment or qualifying practitioner constitutes grounds for
947	discipline of the qualifying practitioner by the appropriate
948	regulatory board.
949	4.  The purchase of prescription drugs by the health care
950	clinic establishment is prohibited during any period of time
951	when the establishment does not comply with this paragraph.
952	5.  A health care clinic establishment permit is not a
953	pharmacy permit or otherwise subject to chapter 465. A health
954	care clinic establishment that meets the criteria of a modified
955	Class II institutional pharmacy under s. 465.019 is not eligible
956	to be permitted under this paragraph.
957	6.  This paragraph does not apply to the purchase of a
958	prescription drug by a licensed practitioner under his or her
959	license. A professional corporation or limited liability company
960	composed of dentists and operating as authorized in s. 466.0285
961	may pay for prescription drugs obtained by a practitioner
962	licensed under chapter 466, and the licensed practitioner is
963	deemed the purchaser and owner of the prescription drugs.
964	Section 24.  Paragraph (a) of subsection (6) of section
965	624.91, Florida Statutes, is amended to read:
966	624.91  The Florida Healthy Kids Corporation Act.-
967	(6)  BOARD OF DIRECTORS.-
968	(a)  The Florida Healthy Kids Corporation shall operate
969	subject to the supervision and approval of a board of directors
970	chaired by the Chief Financial Officer or her or his designee,
971	and composed of 12 11 other members selected for 3-year terms of
972	office as follows:
973	1.  The Secretary of Health Care Administration, or his or
974	her designee.
975	2.  One member appointed by the Commissioner of Education
976	from the Office of School Health Programs of the Florida
977	Department of Education.
978	3.  One member appointed by the Chief Financial Officer
979	from among three members nominated by the Florida Pediatric
980	Society.
981	4.  One member, appointed by the Governor, who represents
982	the Children's Medical Services Program.
983	5.  One member appointed by the Chief Financial Officer
984	from among three members nominated by the Florida Hospital
985	Association.
986	6.  One member, appointed by the Governor, who is an expert
987	on child health policy.
988	7.  One member, appointed by the Chief Financial Officer,
989	from among three members nominated by the Florida Academy of
990	Family Physicians.
991	8.  One member, appointed by the Governor, who represents
992	the state Medicaid program.
993	9.  One member, appointed by the Chief Financial Officer,
994	from among three members nominated by the Florida Association of
995	Counties.
996	10.  The State Health Officer or her or his designee.
997	11.  The Secretary of Children and Family Services, or his
998	or her designee.
999	12.  One member, appointed by the Governor, from among
1000	three members nominated by the Florida Dental Association.
1001	Section 25.  Section 381.0403, Florida Statutes, is amended
1002	to read:
1003	381.0403  The Community Hospital Education Act.-
1004	(1)  SHORT TITLE.-This section shall be known and cited as
1005	"The Community Hospital Education Act."
1006	(2)  LEGISLATIVE INTENT.-
1007	(a)  It is the intent of the Legislature that health care
1008	services for the citizens of this state be upgraded and that a
1009	program for continuing these services be maintained through a
1010	plan for community medical education. The program is intended to
1011	provide additional outpatient and inpatient services, a
1012	continuing supply of highly trained physicians, and graduate
1013	medical education.
1014	(b)  The Legislature further acknowledges the critical need
1015	for increased numbers of primary care physicians to provide the
1016	necessary current and projected health and medical services. In
1017	order to meet both present and anticipated needs, the
1018	Legislature supports an expansion in the number of family
1019	practice residency positions. The Legislature intends that the
1020	funding for graduate education in family practice be maintained
1021	and that funding for all primary care specialties be provided at
1022	a minimum of $10,000 per resident per year. Should funding for
1023	this act remain constant or be reduced, it is intended that all
1024	programs funded by this act be maintained or reduced
1025	proportionately.
1026	(3)  PROGRAM FOR COMMUNITY HOSPITAL EDUCATION; STATE AND
1027	LOCAL PLANNING.-
1028	(a)  There is established under the Department of Health a
1029	program for statewide graduate medical education. It is intended
1030	that continuing graduate medical education programs for interns
1031	and residents be established on a statewide basis. The program
1032	shall provide financial support for primary care specialty
1033	interns and residents based on policies recommended and approved
1034	by the Community Hospital Education Council, herein established,
1035	and the Department of Health. Only those programs with at least
1036	three residents or interns in each year of the training program
1037	are qualified to apply for financial support. Programs with
1038	fewer than three residents or interns per training year are
1039	qualified to apply for financial support, but only if the
1040	appropriate accrediting entity for the particular specialty has
1041	approved the program for fewer positions. Programs added after
1042	fiscal year 1997-1998 shall have 5 years to attain the requisite
1043	number of residents or interns. When feasible and to the extent
1044	allowed through the General Appropriations Act, state funds
1045	shall be used to generate federal matching funds under Medicaid,
1046	or other federal programs, and the resulting combined state and
1047	federal funds shall be allocated to participating hospitals for
1048	the support of graduate medical education. The department may
1049	spend up to $75,000 of the state appropriation for
1050	administrative costs associated with the production of the
1051	annual report as specified in subsection (9), and for
1052	administration of the program.
1053	(b)  For the purposes of this section, primary care
1054	specialties include emergency medicine, family practice,
1055	internal medicine, pediatrics, psychiatry,
1056	obstetrics/gynecology, and combined pediatrics and internal
1057	medicine, and other primary care specialties as may be included
1058	by the council and Department of Health.
1059	(c)  Medical institutions throughout the state may apply to
1060	the Community Hospital Education Council for grants-in-aid for
1061	financial support of their approved programs. Recommendations
1062	for funding of approved programs shall be forwarded to the
1063	Department of Health.
1064	(d)  The program shall provide a plan for community
1065	clinical teaching and training with the cooperation of the
1066	medical profession, hospitals, and clinics. The plan shall also
1067	include formal teaching opportunities for intern and resident
1068	training. In addition, the plan shall establish an off-campus
1069	medical faculty with university faculty review to be located
1070	throughout the state in local communities.
1071	(4)  PROGRAM FOR GRADUATE MEDICAL EDUCATION INNOVATIONS.-
1072	(a)  There is established under the Department of Health a
1073	program for fostering graduate medical education innovations.
1074	Funds appropriated annually by the Legislature for this purpose
1075	shall be distributed to participating hospitals or consortia of
1076	participating hospitals and Florida medical schools or to a
1077	Florida medical school for the direct costs of providing
1078	graduate medical education in community-based clinical settings
1079	on a competitive grant or formula basis to achieve state health
1080	care workforce policy objectives, including, but not limited to:
1081	1.  Increasing the number of residents in primary care and
1082	other high demand specialties or fellowships;
1083	2.  Enhancing retention of primary care physicians in
1084	Florida practice;
1085	3.  Promoting practice in medically underserved areas of
1086	the state;
1087	4.  Encouraging racial and ethnic diversity within the
1088	state's physician workforce; and
1089	5.  Encouraging increased production of geriatricians.
1090	(b)  Participating hospitals or consortia of participating
1091	hospitals and Florida medical schools or a Florida medical
1092	school providing graduate medical education in community-based
1093	clinical settings may apply to the Community Hospital Education
1094	Council for funding under this innovations program, except when
1095	such innovations directly compete with services or programs
1096	provided by participating hospitals or consortia of
1097	participating hospitals, or by both hospitals and consortia.
1098	Innovations program funding shall provide funding based on
1099	policies recommended and approved by the Community Hospital
1100	Education Council and the Department of Health.
1101	(c)  Participating hospitals or consortia of participating
1102	hospitals and Florida medical schools or Florida medical schools
1103	awarded an innovations grant shall provide the Community
1104	Hospital Education Council and Department of Health with an
1105	annual report on their project.
1106	(4)(5)  FAMILY PRACTICE RESIDENCIES.-In addition to the
1107	programs established in subsection (3), the Community Hospital
1108	Education Council and the Department of Health shall establish
1109	an ongoing statewide program of family practice residencies. The
1110	administration of this program shall be in the manner described
1111	in this section.
1112	(5)(6)  COUNCIL AND DIRECTOR.-
1113	(a)  There is established the Community Hospital Education
1114	Council, hereinafter referred to as the council, which shall
1115	consist of 11 members, as follows:
1116	1.  Seven members must be program directors of accredited
1117	graduate medical education programs or practicing physicians who
1118	have faculty appointments in accredited graduate medical
1119	education programs. Six of these members must be board certified
1120	or board eligible in family practice, internal medicine,
1121	pediatrics, emergency medicine, obstetrics-gynecology, and
1122	psychiatry, respectively, and licensed pursuant to chapter 458.
1123	No more than one of these members may be appointed from any one
1124	specialty. One member must be licensed pursuant to chapter 459.
1125	2.  One member must be a representative of the
1126	administration of a hospital with an approved community hospital
1127	medical education program;
1128	3.  One member must be the dean of a medical school in this
1129	state; and
1130	4.  Two members must be consumer representatives.
1131
1132	All of the members shall be appointed by the Governor for terms
1133	of 4 years each.
1134	(b)  Council membership shall cease when a member's
1135	representative status no longer exists. Members of similar
1136	representative status shall be appointed to replace retiring or
1137	resigning members of the council.
1138	(c)  The State Surgeon General shall designate an
1139	administrator to serve as staff director. The council shall
1140	elect a chair from among its membership. Such other personnel as
1141	may be necessary to carry out the program shall be employed as
1142	authorized by the Department of Health.
1143	(6)(7)  DEPARTMENT OF HEALTH; STANDARDS.-
1144	(a)  The Department of Health, with recommendations from
1145	the council, shall establish standards and policies for the use
1146	and expenditure of graduate medical education funds appropriated
1147	pursuant to subsection (7) (8) for a program of community
1148	hospital education. The Department of Health shall establish
1149	requirements for hospitals to be qualified for participation in
1150	the program which shall include, but not be limited to:
1151	1.  Submission of an educational plan and a training
1152	schedule.
1153	2.  A determination by the council to ascertain that each
1154	portion of the program of the hospital provides a high degree of
1155	academic excellence and is accredited by the Accreditation
1156	Council for Graduate Medical Education of the American Medical
1157	Association or is accredited by the American Osteopathic
1158	Association.
1159	3.  Supervision of the educational program of the hospital
1160	by a physician who is not the hospital administrator.
1161	(b)  The Department of Health shall periodically review the
1162	educational program provided by a participating hospital to
1163	assure that the program includes a reasonable amount of both
1164	formal and practical training and that the formal sessions are
1165	presented as scheduled in the plan submitted by each hospital.
1166	(c)  In years that funds are transferred to the Agency for
1167	Health Care Administration, the Department of Health shall
1168	certify to the Agency for Health Care Administration on a
1169	quarterly basis the number of primary care specialty residents
1170	and interns at each of the participating hospitals for which the
1171	Community Hospital Education Council and the department
1172	recommends funding.
1173	(7)(8)  MATCHING FUNDS.-State funds shall be used to match
1174	funds from any local governmental or hospital source. The state
1175	shall provide up to 50 percent of the funds, and the community
1176	hospital medical education program shall provide the remainder.
1177	However, except for fixed capital outlay, the provisions of this
1178	subsection shall not apply to any program authorized under the
1179	provisions of subsection (5) for the first 3 years after such
1180	program is in operation.
1181	(9)  ANNUAL REPORT ON GRADUATE MEDICAL EDUCATION;
1182	COMMITTEE.-The Executive Office of the Governor, the Department
1183	of Health, and the Agency for Health Care Administration shall
1184	collaborate to establish a committee that shall produce an
1185	annual report on graduate medical education. The committee shall
1186	be comprised of 11 members: five members shall be deans of the
1187	medical schools or their designees; the Governor shall appoint
1188	two members, one of whom must be a representative of the Florida
1189	Medical Association who has supervised or currently supervises
1190	residents or interns and one of whom must be a representative of
1191	the Florida Hospital Association; the Secretary of Health Care
1192	Administration shall appoint two members, one of whom must be a
1193	representative of a statutory teaching hospital and one of whom
1194	must be a physician who has supervised or is currently
1195	supervising residents or interns; and the State Surgeon General
1196	shall appoint two members, one of whom must be a representative
1197	of a statutory family practice teaching hospital and one of whom
1198	must be a physician who has supervised or is currently
1199	supervising residents or interns. With the exception of the
1200	deans, members shall serve 4-year terms. In order to stagger the
1201	terms, the Governor's appointees shall serve initial terms of 4
1202	years, the State Surgeon General's appointees shall serve
1203	initial terms of 3 years, and the Secretary of Health Care
1204	Administration's appointees shall serve initial terms of 2
1205	years. A member's term shall be deemed terminated when the
1206	member's representative status no longer exists. Once the
1207	committee is appointed, it shall elect a chair to serve for a 1-
1208	year term. The report shall be provided to the Governor, the
1209	President of the Senate, and the Speaker of the House of
1210	Representatives by January 15 annually. Committee members shall
1211	serve without compensation. The report shall address the
1212	following:
1213	(a)  The role of residents and medical faculty in the
1214	provision of health care.
1215	(b)  The relationship of graduate medical education to the
1216	state's physician workforce.
1217	(c)  The costs of training medical residents for hospitals,
1218	medical schools, teaching hospitals, including all hospital-
1219	medical affiliations, practice plans at all of the medical
1220	schools, and municipalities.
1221	(d)  The availability and adequacy of all sources of
1222	revenue to support graduate medical education and recommend
1223	alternative sources of funding for graduate medical education.
1224	(e)  The use of state and federal appropriated funds for
1225	graduate medical education by hospitals receiving such funds.
1226	(9)(10)  RULEMAKING.-The department has authority to adopt
1227	rules pursuant to ss. 120.536(1) and 120.54 to implement the
1228	provisions of this section.
1229	Section 26.  Section 381.4018, Florida Statutes, is amended
1230	to read:
1231	381.4018  Physician workforce assessment and development.-
1232	(1)  DEFINITIONS.-As used in this section, the term:
1233	(a)  "Consortium" or "consortia" means a combination of
1234	statutory teaching hospitals, statutory rural hospitals, other
1235	hospitals, accredited medical schools, clinics operated by the
1236	department, clinics operated by the Department of Veterans'
1237	Affairs, area health education centers, community health
1238	centers, federally qualified health centers, prison clinics,
1239	local community clinics, or other programs. At least one member
1240	of the consortium shall be a sponsoring institution accredited
1241	or currently seeking accreditation by the Accreditation Council
1242	for Graduate Medical Education or the American Osteopathic
1243	Association.
1244	(b)  "Council" means the Physician Workforce Advisory
1245	Council.
1246	(c)  "Department" means the Department of Health.
1247	(d)  "Graduate medical education program" means a program
1248	accredited by the Accreditation Council for Graduate Medical
1249	Education or the American Osteopathic Association.
1250	(e)  "Primary care specialty" means emergency medicine,
1251	family practice, internal medicine, pediatrics, psychiatry,
1252	geriatrics, general surgery, obstetrics and gynecology, and
1253	combined pediatrics and internal medicine and other specialties
1254	as determined by the Physician Workforce Advisory Council or the
1255	Department of Health.
1256	(2)(1)  LEGISLATIVE INTENT.-The Legislature recognizes that
1257	physician workforce planning is an essential component of
1258	ensuring that there is an adequate and appropriate supply of
1259	well-trained physicians to meet this state's future health care
1260	service needs as the general population and elderly population
1261	of the state increase. The Legislature finds that items to
1262	consider relative to assessing the physician workforce may
1263	include physician practice status; specialty mix; geographic
1264	distribution; demographic information, including, but not
1265	limited to, age, gender, race, and cultural considerations; and
1266	needs of current or projected medically underserved areas in the
1267	state. Long-term strategic planning is essential as the period
1268	from the time a medical student enters medical school to
1269	completion of graduate medical education may range from 7 to 10
1270	years or longer. The Legislature recognizes that strategies to
1271	provide for a well-trained supply of physicians must include
1272	ensuring the availability and capacity of quality graduate
1273	medical schools and graduate medical education programs in this
1274	state, as well as using new or existing state and federal
1275	programs providing incentives for physicians to practice in
1276	needed specialties and in underserved areas in a manner that
1277	addresses projected needs for physician manpower.
1278	(3)(2)  PURPOSE.-The department of Health shall serve as a
1279	coordinating and strategic planning body to actively assess the
1280	state's current and future physician workforce needs and work
1281	with multiple stakeholders to develop strategies and
1282	alternatives to address current and projected physician
1283	workforce needs.
1284	(4)(3)  GENERAL FUNCTIONS.-The department shall maximize
1285	the use of existing programs under the jurisdiction of the
1286	department and other state agencies and coordinate governmental
1287	and nongovernmental stakeholders and resources in order to
1288	develop a state strategic plan and assess the implementation of
1289	such strategic plan. In developing the state strategic plan, the
1290	department shall:
1291	(a)  Monitor, evaluate, and report on the supply and
1292	distribution of physicians licensed under chapter 458 or chapter
1293	459. The department shall maintain a database to serve as a
1294	statewide source of data concerning the physician workforce.
1295	(b)  Develop a model and quantify, on an ongoing basis, the
1296	adequacy of the state's current and future physician workforce
1297	as reliable data becomes available. Such model must take into
1298	account demographics, physician practice status, place of
1299	education and training, generational changes, population growth,
1300	economic indicators, and issues concerning the "pipeline" into
1301	medical education.
1302	(c)  Develop and recommend strategies to determine whether
1303	the number of qualified medical school applicants who might
1304	become competent, practicing physicians in this state will be
1305	sufficient to meet the capacity of the state's medical schools.
1306	If appropriate, the department shall, working with
1307	representatives of appropriate governmental and nongovernmental
1308	entities, develop strategies and recommendations and identify
1309	best practice programs that introduce health care as a
1310	profession and strengthen skills needed for medical school
1311	admission for elementary, middle, and high school students, and
1312	improve premedical education at the precollege and college level
1313	in order to increase this state's potential pool of medical
1314	students.
1315	(d)  Develop strategies to ensure that the number of
1316	graduates from the state's public and private allopathic and
1317	osteopathic medical schools is are adequate to meet physician
1318	workforce needs, based on the analysis of the physician
1319	workforce data, so as to provide a high-quality medical
1320	education to students in a manner that recognizes the uniqueness
1321	of each new and existing medical school in this state.
1322	(e)  Pursue strategies and policies to create, expand, and
1323	maintain graduate medical education positions in the state based
1324	on the analysis of the physician workforce data. Such strategies
1325	and policies must take into account the effect of federal
1326	funding limitations on the expansion and creation of positions
1327	in graduate medical education. The department shall develop
1328	options to address such federal funding limitations. The
1329	department shall consider options to provide direct state
1330	funding for graduate medical education positions in a manner
1331	that addresses requirements and needs relative to accreditation
1332	of graduate medical education programs. The department shall
1333	consider funding residency positions as a means of addressing
1334	needed physician specialty areas, rural areas having a shortage
1335	of physicians, and areas of ongoing critical need, and as a
1336	means of addressing the state's physician workforce needs based
1337	on an ongoing analysis of physician workforce data.
1338	(f)  Develop strategies to maximize federal and state
1339	programs that provide for the use of incentives to attract
1340	physicians to this state or retain physicians within the state.
1341	Such strategies should explore and maximize federal-state
1342	partnerships that provide incentives for physicians to practice
1343	in federally designated shortage areas. Strategies shall also
1344	consider the use of state programs, such as the Florida Health
1345	Service Corps established pursuant to s. 381.0302 and the
1346	Medical Education Reimbursement and Loan Repayment Program
1347	pursuant to s. 1009.65, which provide for education loan
1348	repayment or loan forgiveness and provide monetary incentives
1349	for physicians to relocate to underserved areas of the state.
1350	(g)  Coordinate and enhance activities relative to
1351	physician workforce needs, undergraduate medical education, and
1352	graduate medical education, and reentry of retired military and
1353	other physicians into the physician workforce provided by the
1354	Division of Medical Quality Assurance, the Community Hospital
1355	Education Program and the Graduate Medical Education Committee
1356	established pursuant to s. 381.0403, area health education
1357	center networks established pursuant to s. 381.0402, and other
1358	offices and programs within the department of Health as
1359	designated by the State Surgeon General.
1360	(h)  Work in conjunction with and act as a coordinating
1361	body for governmental and nongovernmental stakeholders to
1362	address matters relating to the state's physician workforce
1363	assessment and development for the purpose of ensuring an
1364	adequate supply of well-trained physicians to meet the state's
1365	future needs. Such governmental stakeholders shall include, but
1366	need not be limited to, the State Surgeon General or his or her
1367	designee, the Commissioner of Education or his or her designee,
1368	the Secretary of Health Care Administration or his or her
1369	designee, and the Chancellor of the State University System or
1370	his or her designee from the Board of Governors of the State
1371	University System, and, at the discretion of the department,
1372	other representatives of state and local agencies that are
1373	involved in assessing, educating, or training the state's
1374	current or future physicians. Other stakeholders shall include,
1375	but need not be limited to, organizations representing the
1376	state's public and private allopathic and osteopathic medical
1377	schools; organizations representing hospitals and other
1378	institutions providing health care, particularly those that
1379	currently provide or have an interest in providing accredited
1380	medical education and graduate medical education to medical
1381	students and medical residents; organizations representing
1382	allopathic and osteopathic practicing physicians; and, at the
1383	discretion of the department, representatives of other
1384	organizations or entities involved in assessing, educating, or
1385	training the state's current or future physicians.
1386	(i)  Serve as a liaison with other states and federal
1387	agencies and programs in order to enhance resources available to
1388	the state's physician workforce and medical education continuum.
1389	(j)  Act as a clearinghouse for collecting and
1390	disseminating information concerning the physician workforce and
1391	medical education continuum in this state.
1392	(5)  PHYSICIAN WORKFORCE ADVISORY COUNCIL.-There is created
1393	in the department the Physician Workforce Advisory Council, an
1394	advisory council as defined in s. 20.03. The council shall
1395	comply with the requirements of s. 20.052, except as otherwise
1396	provided in this section.
1397	(a)  The council shall consist of 19 members. Members
1398	appointed by the State Surgeon General shall include:
1399	1.  A designee from the department who is a physician
1400	licensed under chapter 458 or chapter 459 and recommended by the
1401	State Surgeon General.
1402	2.  An individual who is affiliated with the Science
1403	Students Together Reaching Instructional Diversity and
1404	Excellence program and recommended by the area health education
1405	center network.
1406	3.  Two individuals who are recommended by the Council of
1407	Florida Medical School Deans, one who represents a college of
1408	allopathic medicine and one who represents a college of
1409	osteopathic medicine.
1410	4.  One individual who is recommended by the Florida
1411	Hospital Association and represents a hospital that is licensed
1412	under chapter 395, has an accredited graduate medical education
1413	program, and is not a statutory teaching hospital.
1414	5.  One individual who represents a statutory teaching
1415	hospital as defined in s. 408.07 and is recommended by the
1416	Safety Net Hospital Alliance.
1417	6.  One individual who represents a family practice
1418	teaching hospital as defined in s. 395.805 and is recommended by
1419	the Council of Family Medicine and Community Teaching Hospitals.
1420	7.  Two individuals who are recommended by the Florida
1421	Medical Association, one who represents a primary care specialty
1422	and one who represents a nonprimary care specialty.
1423	8.  Two individuals who are recommended by the Florida
1424	Osteopathic Medical Association, one who represents a primary
1425	care specialty and one who represents a nonprimary care
1426	specialty.
1427	9.  Two individuals who are program directors of accredited
1428	graduate medical education programs, one who represents a
1429	program that is accredited by the Accreditation Council for
1430	Graduate Medical Education and one who represents a program that
1431	is accredited by the American Osteopathic Association.
1432	10.  An individual who is recommended by the Florida
1433	Association of Community Health Centers and represents a
1434	federally qualified health center located in a rural area as
1435	defined in s. 381.0406(2)(a).
1436	11.  An individual who is recommended by the Florida
1437	Academy of Family Physicians.
1438	12.  An individual who is recommended by the Florida
1439	Alliance for Health Professions Diversity.
1440	13.  The Chancellor of the State University System or his
1441	or her designee.
1442	14.  A layperson member as determined by the State Surgeon
1443	General.
1444
1445	Each entity authorized to make recommendations under this
1446	subsection shall make at least two recommendations to the State
1447	Surgeon General for each appointment to the council. The State
1448	Surgeon General shall name one appointee for each position from
1449	the recommendations made by each authorized entity.
1450	(b)  Each council member shall be appointed to a 4-year
1451	term. An individual may not serve more than two terms. Any
1452	council member may be removed from office for malfeasance,
1453	misfeasance, neglect of duty, incompetence, permanent inability
1454	to perform official duties, or pleading guilty or nolo
1455	contendere to, or being found guilty of, a felony. Any council
1456	member who meets the criteria for removal, or who is otherwise
1457	unwilling or unable to properly fulfill the duties of the
1458	office, shall be succeeded by an individual chosen by the State
1459	Surgeon General to serve out the remainder of the council
1460	member's term. If the remainder of the replaced council member's
1461	term is less than 18 months, notwithstanding the provisions of
1462	this paragraph, the succeeding council member may be reappointed
1463	twice by the State Surgeon General.
1464	(c)  The chair of the council is the State Surgeon General,
1465	who shall designate a vice chair from the membership of the
1466	council to serve in the absence of the State Surgeon General. A
1467	vacancy shall be filled for the remainder of the unexpired term
1468	in the same manner as the original appointment.
1469	(d)  Council members are not entitled to receive
1470	compensation or reimbursement for per diem or travel expenses.
1471	(e)  The council shall meet at least twice a year in person
1472	or by teleconference.
1473	(f)  The council shall:
1474	1.  Advise the State Surgeon General and the department on
1475	matters concerning current and future physician workforce needs
1476	in this state;
1477	2.  Review survey materials and the compilation of survey
1478	information;
1479	3.  Annually review the number, location, cost, and
1480	reimbursement of graduate medical education programs and
1481	positions;
1482	4.  Provide recommendations to the department regarding the
1483	survey completed by physicians licensed under chapter 458 or
1484	chapter 459;
1485	5.  Assist the department in preparing the annual report to
1486	the Legislature pursuant to ss. 458.3192 and 459.0082;
1487	6.  Assist the department in preparing an initial strategic
1488	plan, conduct ongoing strategic planning in accordance with this
1489	section, and provide ongoing advice on implementing the
1490	recommendations;
1491	7.  Monitor and provide recommendations regarding the need
1492	for an increased number of primary care or other physician
1493	specialties to provide the necessary current and projected
1494	health and medical services for the state; and
1495	8.  Monitor and make recommendations regarding the status
1496	of the needs relating to graduate medical education in this
1497	state.
1498	(6)  PHYSICIAN WORKFORCE GRADUATE MEDICAL EDUCATION
1499	INNOVATION PILOT PROJECTS.-
1500	(a)  The Legislature finds that:
1501	1.  In order to ensure a physician workforce that is
1502	adequate to meet the needs of this state's residents and its
1503	health care system, policymakers must consider the education and
1504	training of future generations of well-trained health care
1505	providers.
1506	2.  Physicians are likely to practice in the state where
1507	they complete their graduate medical education.
1508	3.  It can directly affect the makeup of the physician
1509	workforce by selectively funding graduate medical education
1510	programs to provide needed specialists in geographic areas of
1511	the state that have a deficient number of such specialists.
1512	4.  Developing additional positions in graduate medical
1513	education programs is essential to the future of this state's
1514	health care system.
1515	5.  It was necessary in 2007 to pass legislation that
1516	provided for an assessment of the status of this state's current
1517	and future physician workforce. The department is collecting and
1518	analyzing information on an ongoing basis to assess this state's
1519	physician workforce needs, and such assessment may facilitate
1520	the determination of graduate medical education needs and
1521	strategies for the state.
1522	(b)  There is established under the department a program to
1523	foster innovative graduate medical education pilot projects that
1524	are designed to promote the expansion of graduate medical
1525	education programs or positions to prepare physicians to
1526	practice in needed specialties and underserved areas or settings
1527	and to provide demographic and cultural representation in a
1528	manner that addresses current and projected needs for this
1529	state's physician workforce. Funds appropriated annually by the
1530	Legislature for this purpose shall be distributed to
1531	participating hospitals, medical schools, other sponsors of
1532	graduate medical education programs, consortia engaged in
1533	developing new graduate medical education programs or positions
1534	in those programs, or pilot projects providing innovative
1535	graduate medical education in community-based clinical settings.
1536	Pilot projects shall be selected on a competitive grant basis,
1537	subject to available funds.
1538	(c)  Pilot projects shall be designed to meet one or more
1539	of this state's physician workforce needs, as determined
1540	pursuant to this section, including, but not limited to:
1541	1.  Increasing the number of residencies or fellowships in
1542	primary care or other needed specialties.
1543	2.  Enhancing the retention of primary care physicians or
1544	other needed specialties in this state.
1545	3.  Promoting practice in rural or medically underserved
1546	areas of the state.
1547	4.  Encouraging racial and ethnic diversity within the
1548	state's physician workforce.
1549	5.  Encouraging practice in community health care or other
1550	ambulatory care settings.
1551	6.  Encouraging practice in clinics operated by the
1552	department, including, but not limited to, county health
1553	departments, clinics operated by the Department of Veterans'
1554	Affairs, prison clinics, or similar settings of need.
1555	7.  Encouraging the increased production of geriatricians.
1556	(d)  Priority shall be given to a proposal for a pilot
1557	project that:
1558	1.  Demonstrates a collaboration of federal, state, and
1559	local entities that are public or private.
1560	2.  Obtains funding from multiple sources.
1561	3.  Focuses on enhancing graduate medical education in
1562	rural or underserved areas.
1563	4.  Focuses on enhancing graduate medical education in
1564	ambulatory or community-based settings other than a hospital
1565	environment.
1566	5.  Includes the use of technology, such as electronic
1567	medical records, distance consultation, and telemedicine, to
1568	ensure that residents are better prepared to care for patients
1569	in this state, regardless of the community in which the
1570	residents practice.
1571	6.  Is designed to meet multiple policy needs as enumerated
1572	in subsection (4).
1573	7.  Uses a consortium to provide for graduate medical
1574	education experiences.
1575	(e)  The department shall adopt by rule appropriate
1576	performance measures to use in order to consistently evaluate
1577	the effectiveness, safety, and quality of the programs, as well
1578	as the impact of each program on meeting this state's physician
1579	workforce needs.
1580	(f)  Participating pilot projects shall submit to the
1581	department an annual report on the project in a manner required
1582	by the department.
1583	(g)  Funding provided to a pilot project may be used only
1584	for the direct costs of providing graduate medical education.
1585	Accounting of such costs and expenditures shall be documented in
1586	the annual report.
1587	(h)  State funds shall be used to supplement funds from any
1588	local government, community, or private source. The state may
1589	provide up to 50 percent of the funds, and local governmental
1590	grants or community or private sources shall provide the
1591	remainder of the funds.
1592	(7)  RULEMAKING.-The department shall adopt rules as
1593	necessary to administer this section.
1594	Section 27.  Section 458.3192, Florida Statutes, is amended
1595	to read:
1596	458.3192  Analysis of survey results; report.-
1597	(1)  Each year, the Department of Health shall analyze the
1598	results of the physician survey required by s. 458.3191 and
1599	determine by geographic area and specialty the number of
1600	physicians who:
1601	(a)  Perform deliveries of children in this state Florida.
1602	(b)  Read mammograms and perform breast-imaging-guided
1603	procedures in this state Florida.
1604	(c)  Perform emergency care on an on-call basis for a
1605	hospital emergency department.
1606	(d)  Plan to reduce or increase emergency on-call hours in
1607	a hospital emergency department.
1608	(e)  Plan to relocate their allopathic or osteopathic
1609	practice outside the state.
1610	(f)  Practice medicine in this state.
1611	(g)  Plan to reduce or modify the scope of their practice.
1612	(2)  The Department of Health must report its findings to
1613	the Governor, the President of the Senate, and the Speaker of
1614	the House of Representatives by November 1 each year. The
1615	department shall also include in its report findings,
1616	recommendations, and strategic planning activities as provided
1617	in s. 381.4018. The department may also include other
1618	information requested by the Physician Workforce Advisory
1619	Council.
1620	Section 28.  Section 459.0082, Florida Statutes, is amended
1621	to read:
1622	459.0082  Analysis of survey results; report.-
1623	(1)  Each year, the Department of Health shall analyze the
1624	results of the physician survey required by s. 459.0081 and
1625	determine by geographic area and specialty the number of
1626	physicians who:
1627	(a)  Perform deliveries of children in this state Florida.
1628	(b)  Read mammograms and perform breast-imaging-guided
1629	procedures in this state Florida.
1630	(c)  Perform emergency care on an on-call basis for a
1631	hospital emergency department.
1632	(d)  Plan to reduce or increase emergency on-call hours in
1633	a hospital emergency department.
1634	(e)  Plan to relocate their allopathic or osteopathic
1635	practice outside the state.
1636	(f)  Practice medicine in this state.
1637	(g)  Plan to reduce or modify the scope of their practice.
1638	(2)  The Department of Health must report its findings to
1639	the Governor, the President of the Senate, and the Speaker of
1640	the House of Representatives by November 1 each year. The
1641	department shall also include in its report findings,
1642	recommendations, and strategic planning activities as provided
1643	in s. 381.4018. The department may also include other
1644	information requested by the Physician Workforce Advisory
1645	Council.
1646	Section 29.  Section 458.315, Florida Statutes, is amended
1647	to read:
1648	458.315  Temporary certificate for practice in areas of
1649	critical need.-
1650	(1)  Any physician who:
1651	(a)  Is licensed to practice in any jurisdiction in the
1652	United States and other state, whose license is currently valid;
1653	or,
1654	(b)  Has served as a physician in the United States Armed
1655	Forces for at least 10 years and received an honorable discharge
1656	from the military;
1657
1658	and who pays an application fee of $300 may be issued a
1659	temporary certificate for to practice in areas of communities of
1660	Florida where there is a critical need for physicians.
1661	(2)  A certificate may be issued to a physician who:
1662	(a)  Practices in an area of critical need;
1663	(b)  Will be employed by or practice in a county health
1664	department, correctional facility, Department of Veterans'
1665	Affairs clinic, community health center funded by s. 329, s.
1666	330, or s. 340 of the United States Public Health Services Act,
1667	or other agency or institution that is approved by the State
1668	Surgeon General and provides health care to meet the needs of
1669	underserved populations in this state; or
1670	(c)  Will practice for a limited time to address critical
1671	physician-specialty, demographic, or geographic needs for this
1672	state's physician workforce as determined by the State Surgeon
1673	General entity that provides health care to indigents and that
1674	is approved by the State Health Officer.
1675	(3)  The Board of Medicine may issue this temporary
1676	certificate with the following restrictions:
1677	(a)(1)  The State Surgeon General board shall determine the
1678	areas of critical need, and the physician so certified may
1679	practice in any of those areas for a time to be determined by
1680	the board. Such areas shall include, but are not be limited to,
1681	health professional shortage areas
1682	States Department of Health and Human
1683	1.(a)  A recipient of a temporary certificate for practice
1684	in areas of critical need may use the certificate license to
1685	work for any approved entity employer in any area of critical
1686	need or as authorized by the State Surgeon General approved by
1687	the board.
1688	2.(b)  The recipient of a temporary certificate for
1689	practice in areas of critical need shall, within 30 days after
1690	accepting employment, notify the board of all approved
1691	institutions in which the licensee practices and of all approved
1692	institutions where practice privileges have been denied.
1693	(b)(2)  The board may administer an abbreviated oral
1694	examination to determine the physician's competency, but a no
1695	written regular examination is not required necessary. Within 60
1696	days after receipt of an application for a temporary
1697	certificate, the board shall review the application and issue
1698	the temporary certificate, or notify the applicant of denial, or
1699	notify the applicant that the board recommends additional
1700	assessment, training, education, or other requirements as a
1701	condition of certification. If the applicant has not actively
1702	practiced during the prior 3 years and the board determines that
1703	the applicant may lack clinical competency, possess diminished
1704	or inadequate skills, lack necessary medical knowledge, or
1705	exhibit patterns of deficits in clinical decisionmaking, the
1706	board may:
1707	1.  Deny the application;
1708	2.  Issue a temporary certificate with reasonable
1709	restrictions that may include, but are not limited to, a
1710	requirement for the applicant to practice under the supervision
1711	of a physician approved by the board; or
1712	3.  Issue a temporary certificate upon receipt of
1713	documentation confirming that the applicant has met any
1714	reasonable conditions of the board which may include, but are
1715	not limited to, completing continuing education or undergoing an
1716	assessment of skills and training.
1717	(c)(3)  Any certificate issued under this section is shall
1718	be valid only so long as the State Surgeon General determines
1719	that the reason area for which it was is issued remains a an
1720	area of critical need to the state. The Board of Medicine shall
1721	review each temporary certificateholder the service within said
1722	area not less than annually to ascertain that the minimum
1723	requirements of the Medical Practice Act and its adopted the
1724	rules and regulations promulgated thereunder are being complied
1725	with. If it is determined that such minimum requirements are not
1726	being met, the board shall forthwith revoke such certificate or
1727	shall impose restrictions or conditions, or both, as a condition
1728	of continued practice under the certificate.
1729	(d)(4)  The board may shall not issue a temporary
1730	certificate for practice in an area of critical need to any
1731	physician who is under investigation in any jurisdiction in the
1732	United States another state for an act that which would
1733	constitute a violation of this chapter until such time as the
1734	investigation is complete, at which time the provisions of s.
1735	458.331 shall apply.
1736	(4)(5)  The application fee and all licensure fees,
1737	including neurological injury compensation assessments, shall be
1738	waived for those persons obtaining a temporary certificate to
1739	practice in areas of critical need for the purpose of providing
1740	volunteer, uncompensated care for low-income residents
1741	Floridians. The applicant must submit an affidavit from the
1742	employing agency or institution stating that the physician will
1743	not receive any compensation for any service involving the
1744	practice of medicine.
1745	Section 30.  Section 459.0076, Florida Statutes, is created
1746	to read:
1747	459.0076  Temporary certificate for practice in areas of
1748	critical need.-
1749	(1)  Any physician who:
1750	(a)  Is licensed to practice in any jurisdiction in the
1751	United States and whose license is currently valid; or
1752	(b)  Has served as a physician in the United States Armed
1753	Forces for at least 10 years and received an honorable discharge
1754	from the military;
1755
1756	and who pays an application fee of $300 may be issued a
1757	temporary certificate for practice in areas of critical need.
1758	(2)  A certificate may be issued to a physician who:
1759	(a)  Will practice in an area of critical need;
1760	(b)  Will be employed by or practice in a county health
1761	department, correctional facility, Department of Veterans'
1762	Affairs clinic, community health center funded by s. 329, s.
1763	330, or s. 340 of the United States Public Health Services Act,
1764	or other agency or institution that is approved by the State
1765	Surgeon General and provides health care to meet the needs of
1766	underserved populations in this state; or
1767	(c)  Will practice for a limited time to address critical
1768	physician-specialty, demographic, or geographic needs for this
1769	state's physician workforce as determined by the State Surgeon
1770	General.
1771	(3)  The Board of Osteopathic Medicine may issue this
1772	temporary certificate with the following restrictions:
1773	(a)  The State Surgeon General shall determine the areas of
1774	critical need. Such areas include, but are not limited to,
1775	health professional shortage areas designated by the United
1776	States Department of Health and Human Services.
1777	1.  A recipient of a temporary certificate for practice in
1778	areas of critical need may use the certificate to work for any
1779	approved entity in any area of critical need or as authorized by
1780	the State Surgeon General.
1781	2.  The recipient of a temporary certificate for practice
1782	in areas of critical need shall, within 30 days after accepting
1783	employment, notify the board of all approved institutions in
1784	which the licensee practices and of all approved institutions
1785	where practice privileges have been denied.
1786	(b)  The board may administer an abbreviated oral
1787	examination to determine the physician's competency, but a
1788	written regular examination is not required. Within 60 days
1789	after receipt of an application for a temporary certificate, the
1790	board shall review the application and issue the temporary
1791	certificate, notify the applicant of denial, or notify the
1792	applicant that the board recommends additional assessment,
1793	training, education, or other requirements as a condition of
1794	certification. If the applicant has not actively practiced
1795	during the prior 3 years and the board determines that the
1796	applicant may lack clinical competency, possess diminished or
1797	inadequate skills, lack necessary medical knowledge, or exhibit
1798	patterns of deficits in clinical decisionmaking, the board may:
1799	1.  Deny the application;
1800	2.  Issue a temporary certificate having reasonable
1801	restrictions that may include, but are not limited to, a
1802	requirement for the applicant to practice under the supervision
1803	of a physician approved by the board; or
1804	3.  Issue a temporary certificate upon receipt of
1805	documentation confirming that the applicant has met any
1806	reasonable conditions of the board, which may include, but are
1807	not limited to, completing continuing education or undergoing an
1808	assessment of skills and training.
1809	(c)  Any certificate issued under this section is valid
1810	only so long as the State Surgeon General determines that the
1811	reason for which it was issued remains a critical need to the
1812	state. The Board of Osteopathic Medicine shall review each
1813	temporary certificateholder not less than annually to ascertain
1814	that the minimum requirements of the Osteopathic Medical
1815	Practice Act and its adopted rules are being complied with. If
1816	it is determined that such minimum requirements are not being
1817	met, the board shall revoke such certificate or shall impose
1818	restrictions or conditions, or both, as a condition of continued
1819	practice under the certificate.
1820	(d)  The board may not issue a temporary certificate for
1821	practice in an area of critical need to any physician who is
1822	under investigation in any jurisdiction in the United States for
1823	an act that would constitute a violation of this chapter until
1824	such time as the investigation is complete, at which time the
1825	provisions of s. 459.015 apply.
1826	(4)  The application fee and all licensure fees, including
1827	neurological injury compensation assessments, shall be waived
1828	for those persons obtaining a temporary certificate to practice
1829	in areas of critical need for the purpose of providing
1830	volunteer, uncompensated care for low-income residents. The
1831	applicant must submit an affidavit from the employing agency or
1832	institution stating that the physician will not receive any
1833	compensation for any service involving the practice of medicine.
1834	Section 31.  This act shall take effect July 1, 2010.

CODING: Words stricken are deletions; words underlined are additions.